The World Turned Upside Down: The Second Low-Carbohydrate Revolution

Table of
Contents

Title
The Summary in Advance

Introduction

Chapter 1
The Summary in Advance

Chapter 2
Whaddaya' Know?

Chapter 3
Answers 2. Introduction to lipid Chemistry

Chapter 4
The first low-carb revolution

Chapter 5
Basic Nutrition: Macronutrients

Chapter 6
Another revolution. Glycogen and gluconeogenesis

Chapter 7
An Introduction to Metabolism. Two goals. Two fuels

Chapter 8
Sugar, Fructose and fructophobia

Chapter 9
Saturated Fat. On your Plate or in your Blood?

Chapter 10
Diabetes

Chapter 11
Wendy's Story - the uses of metabolic adversity

Chapter 12
Metabolic syndrome - the big pitch

Chapter 13
Hunger. What it is. What to do about it

Chapter 14
"Calorie is a calorie," Thermodynamics, and all that

Chapter 15
|Summary: Bad Ideas

Chapter 16
The medical literature. A guide to Flawed Studies

Chapter 17
Observational studies, Association, causality

Chapter 18
Red meat and the new Puritans

Chapter 19
Harvard. Making Americans Afraid of Meat

Chapter 20
Group statistics. Bill Gates walks into a bar

Chapter 21
The Seventh Egg

Chapter 22
Intention-to-Treat. What it is and why you should care

Chapter 23
The Fiend that Lies like truth

Chapter 24
Chemistry and Food. The recipes

Chapter 25
The second low-carb revolution

Chapter 26
Summary and the second revolution

Acknowledgements

Bibliography

Appendix

Copyright © 2014 Richard David Feinman

- - - - - - - - - - -
- - - - - -

Richard David Feinman
Professor of Cell Biology
SUNY Downstate Medical Center

(718) 270-2252
cell (917) 554-7794

email:
[email protected]
blog:
http://feinmantheother.com
http://rdfeinman.wordpress.com/

Vocem meam audiet qui
me tangit

The
World Turned Upside Down:
The Second Low-carbohydrate Revolution

How
the science of
carbohydrate restriction arising from a rag-tag collection of popular
diets
defeated the powerful low-fat army and became the default approach to
health
.

Richard David Feinman,
Ph. D.

Illustrations by Robin
Feinman

In the American
Revolution, when
Cornwallis surrendered at Yorktown (1781), the British supposedly
marched out
playing the popular song "The World Turned Upside Down."
(
http://www.contemplator.com/england/worldtur.html
).
Probably too good
to be
true – the greatest army in the world had lost a war to a bunch of
guerillas – it was a popular song and there are several versions
(http://www.contemplator.com/scotland/kingjoy.html). In America the
song was
also known as Derry Down and The Old Women Taught Wisdom.

If buttercups
buzz'd after the bee,

If boats were on
land, churches on sea,

If ponies rode
men and if grass ate the
cows,

And cats should
be chased into holes by
the mouse,

If the mamas
sold their babies

To the gypsies
for half a crown;

If summer were
spring and the other way
round,

Then all the
world would be upside
down.

INTRODUCTION

I've always had a weight problem.
From old photographs, I
would rarely have been considered fat but I was always trying to lose
weight.
When I was eight years old, I wanted to get thinner in order to look
really
sharp in my Brooklyn Dodgers uniform to impress Barbara Levy who was
pretty
obviously the most beautiful girl in the world. I don't recall having
any great
success and it was only fairly recently that I found out that Barbara
Levy is
now Barbara Boxer, Senator from California. In any case, I always knew
that
starch made me fat –

oddly, I was less afraid of sugar because I
thought,
mistakenly, that there wasn't that much in Coca-Cola and other sodas,
my major
source. I probably grew up with what is usually called a poor
self-image and, as
the old joke goes, inside of every Botero is a Giacometti trying to get
out.

I did know to cut out starch and
obvious solid sugar,
however, and I made other observations, e.g., that cold cereal for
breakfast
made me slightly sick although I can't remember what I did eat. At
least some
of the time, it was bacon and eggs which, in those days, was just one
of the
things that people ate. Nobody recoiled in horror at bacon. The only
dietary
advice was to eat from the different food groups and there were
graphics of pie
charts with little symbols in each piece of the pie. The bottle of milk
was one
that stuck in my mind. I felt early on that it was not interesting. I
knew that
you didn't need an "expert" to tell you what to eat. When the USDA
(United
States Department of Agriculture) food pyramid appeared, I knew it was
a crock
and I assumed that everybody else did too. Everybody knows that, if you
have a
weight problem, bread will make you fat. And if you don't have a weight
problem, why do you need the USDA. I assumed everybody was in agreement
on
that. That was not so. I am not sure why people went along. After all,
it was
about food. Everybody has experience of food. We all do three
experiments in
"nutritional science" each day. It probably had to do with the history
of
medicine. Among the turning points in that history was the discovery of
vitamins. Unlike poisons and microorganisms, this was stuff that if you
didn't
have, made you sick. Another stimulus was the identification of
cigarette smoke
as a causal agent in lung disease. There, even though there was a toxic
agent,
the associations were more subtle and one needed statistics or other
expert
insights to see the connection. This may have given people the idea
that there
were experts who could see harm where we didn't.

In my youth, I simply ignored the
problem. I thought that I
knew what to eat (I was mostly right) and obesity was a personal rather
than a
professional question. Decades later, teaching metabolism, I had to
confront
the interaction of science and nutrition. It proved to be more
difficult than I
would have guessed. This book is the story of nutrition, a story of
biochemistry and metabolism – how you process the food that you eat. It
is an
interesting story of the application of science to daily life. If you
know a
little chemistry, you can appreciate the way that evolution reached
into the
mixing pot of chemical reactions to obtain energy from the environment.
Even if
you don't know chemistry, you can see the beauty in the life machine.
But there
is another side. As you might guess from the contentious and
continually
changing stories in the media, it is also a rather discouraging tale of
the
limitations of human behavior in facing truth and preventing harm. It
is an
almost unbelievable story of very poor and irresponsible science from
the
medical community, the most highly respected part of our society.

The Problem of Experts
and Eating to the Meter

However hard it is for scientists not
to
trust experts, it is
harder for the general population. I was still astounded when I saw a
question
on an online diabetes site that said "My morning oatmeal spikes my
blood
glucose. How much carbohydrate should I have?" The answer from the
experts was
waffling and tedious but never included the advice "Don't eat any more
oatmeal
than that which
doesn't
spike
your blood glucose."

So early on there was my interest in
food
and it remained an
undercurrent. Later in life, it resurfaced in my professional life.
There was
also chemistry.

Chemistry

When I was eight years old, my father
taught me about atoms

I
have one of those memories that may or may
not be accurate: sitting in my father's car, he is telling me that the
whole
world was made of atoms in the same way that the apartment house across
the
street was made of bricks. Whether or not the scene really took place,
it was a
major influence in my life and chemistry was a defining feature of my
life.
(Other vivid memories of my early life in Brooklyn, being at Ebbetts
Field and
seeing Jackie Robinson hit an inside-the-ballpark home run, turn out to
not be
true. He had hit only one, in 1948 before I had ever seen a live game).

The point of atomic theory, the thing
that captures
everybody's imagination when they are first exposed to it, is that it
is a
global and absolute theory; it explains everything that was done in the
laboratory or even in the kitchen. Various fields of chemistry have
that
universal feeling with different degrees of intellectual rigor but
eventually I
recognized that biochemistry was a good place to be if you weren't sure
what
you wanted to be when you grow up. You can do drug design or
theoretical
chemistry or animal behavior or nutrition and still call yourself a
biochemist.

Figure I-1
from Braeckman
et al
.
Intermediary metabolism (February 16, 2009), WormBook, ed. The
C.
elegans
Research Community, WormBook, doi/10.1895/wormbook.1.146.1,
http://www.wormbook.org
.
distributed under terms of the Creative Commons Attribution License

Teaching Nutrition

I have worked in a number of fields
in biochemistry but at
SUNY Downstate Medical Center, where I have been for many years, it was
teaching metabolism to medical students that led me into nutrition in a
professional way.

Metabolism is the study of the
processing of food and the
biochemical reactions that control life functions. It is a fairly
complicated
subject, those parts that we understand. There are the numerous
individual
biochemical reactions and students tend to see the subject the way
somebody
described the study of history: just one damn thing after another.
There are
general principles and big concepts but you do have to know the
details. Not
all the details. Not all the stuff on the scary metabolic chart. At the
end of
the book, it'll be less scary.

Figure
I-2
Insulin as a master controller of
metabolism. In the fed
state, stimulation of insulin secretion by the pancreas leads to
protein
synthesis, fat storage and maintenance of glycogen stores.

I used low-carbohydrate diets – at
the time primarily a
weight loss diet – as a heuristic device, that is, teaching method.
Control of
blood glucose and insulin (the hormone whose release is controlled by
glucose)
is really central to many different processes in biochemistry. The main
idea is
that in the complicated network of biochemical reactions, insulin
stands out as
a major point of regulation.
Figure
I-2
shows how
we describe it to medical students and this is how we will describe it
here.
The ups and downs of insulin are what we try to control in the use of
dietary
carbohydrate restriction as a therapeutic method. So, low-carbohydrate
diets
provided some unifying theme in teaching. I still teach it that way
although
now we emphasize diabetes where impaired ability to handle dietary
carbohydrate
is the salient feature. Low-carbohydrate diets are also popular –
periodically
very popular. It is likely that the current revolution can't be turned
back. I
and other people who use this teaching method have described how the
real world
can help learn the chemistry
[1-3]
.

Around 2000, one of our medical
students
who had been a dietitian
– we have several second career students – had a suggestion for our
course. Her
recommendation was to include formal nutrition in the biochemistry
course and
she provided subject matter from standard nutritional practice. I
cannot really
describe what it was about – probably, even at the time, it was so
vacuous that
it could not be retained in memory. Anyway, at first I objected because
whatever it was, it wasn't about biochemistry. Criticizing how lectures
are
given is, of course, like complaining about how the dishes are done:
everybody
sees an immediate solution. I wound up having to give formal lectures
in
nutrition. I really didn't know the literature. I had long-ago found
that
carbohydrate restriction was best for me and, while low-carbohydrate
diets
provided me with a good framework for teaching metabolism, therapies do
not
always have a close relation to theories so it all involved a certain
amount of
background study.

My first lectures on nutrition were
pretty
much neutral. I simply
tried to cover some aspects of low-carbohydrate and low-fat diets
(these really
are the two main choices) presenting the pros and cons of the different
approaches in a simple way. Low-fat diets are not based substantially
on
biochemical mechanisms. They follow, mostly from observations,
correlations
between the presence of cholesterol or other lipids in the blood and
cardiovascular disease – at least initially this was the main focus –
or, as it
morphed into a recommendation on obesity, it started emphasizing the
point that
fat has more calories per gram than other things and the obvious
assumption
that the more calories, the greater the effect on body weight – the
ill-fated idea
that "you are what you eat" which hangs over everything. Because
metabolism
explained, in some way, the apparent benefits of a low-carb diet, that
did not
mean that I could document the effects with established information
from
published science. So, my lectures were rather simple and
straight-forward
while I tried to get a grip on the scientific literature. It didn't
take long
to see that something was terribly wrong. In simply trying to get some
of the
facts, I stepped into a world of bad science, self-deception and a
scandal
equal to any in the history of medicine.

The Nurses Health
Initiative.

Science is very specialized. Although
I
had been doing research
on blood coagulation, obviously related to cardiovascular disease
(CVD), I did
not pay much attention to the diet-heart hypothesis – the idea that fat
and
cholesterol in the diet raises blood cholesterol which, in turn, leads
to CVD.
I
was
suspicious
of such a theory because biology tends to run on hormones and enzymes,
that is,
control mechanisms, not on mass action (the principle that chemical
processes
are determined by how much reactants are put into them). The grand
principle in
biochemistry is that there is hardly anything that is not connected
with
feedback. If you try to lower your dietary cholesterol, the liver will
respond
by making more. So simply adding more or less is not guaranteed to give
much
change at all and I was skeptical if not well-informed.

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